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A Novel Protocol for Contact Isolation for Multidrug-Resistant Organisms in Children on Inpatient Rehabilitation and
Kelly L D Pham1,2,3,4, Kristie F Bjornson1,2,3,4, Marisa Osorio1,2,3,4
1Department of Rehabilitation Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA.
Background:
The incidence of contact isolation for multidrug-resistant organisms is increasing in acute hospitals and inpatient rehabilitation units alike. There is limited evidence on the effect of contact isolation on functional outcomes during inpatient rehabilitation.
Objective:
To determine whether the use of a modified contact isolation protocol (MCI) resulted in noninferior functional outcomes compared with children without contact isolation (NCI) on inpatient rehabilitation.
Design:
This is a retrospective noninferiority study.
Setting:
One academically affiliated pediatric inpatient rehabilitation unit located in a children's hospital.
Patients:
All children with any diagnosis admitted to inpatient rehabilitation from January 1, 2007, to December 31, 2014.
Methods Or Interventions:
We compared functional outcomes for 2 groups of children.
Main Outcome Measurements:
Primary outcome measures included the Functional Independence Measure for Children (WeeFIM) efficiency and the change in the Developmental Functional Quotient (DFQ) for the WeeFIM. Noninferiority margins of 0.63 for the WeeFIM efficiency and 0.092 for the change in DFQ for the WeeFIM were used.
Results:
There were a total of 949 patients of whom 899 were NCI, 48 MCI, and 2 excluded due to missing information. Patients with MCI had functional outcomes that were noninferior to those with NCI including the WeeFIM efficiency (mean difference 0.002, 95% CI -0.38 to 0.404) and the change in DFQ for the WeeFIM (mean difference -0.05, 95% CI -0.058 to 0.003).
Conclusions:
The modified contact isolation protocol, having resulted in noninferior functional outcomes in inpatient rehabilitation may provide adequate contact isolation while allowing for noninferior functional outcomes. This may be a guide in the face of an ever-increasing need for contact isolation.
Level Of Evidence:
III.
Insights
A modified contact isolation protocol (MCI) demonstrated noninferior functional outcomes in pediatric inpatient rehabilitation compared to standard care. This approach balances infection control with patient functional progress in rehabilitation settings.
Area of Science:
- Pediatric Rehabilitation Medicine
- Infectious Disease Control
- Healthcare Quality Improvement
Background:
- Increasing incidence of multidrug-resistant organisms necessitates contact isolation in acute and rehabilitation settings.
- Limited evidence exists on the impact of contact isolation on functional outcomes during inpatient rehabilitation.
Purpose of the Study:
- To evaluate if a modified contact isolation protocol (MCI) yields noninferior functional outcomes compared to no contact isolation (NCI) in pediatric inpatient rehabilitation.
- To assess the efficacy of MCI in maintaining functional progress while implementing infection control measures.
Main Methods:
- Retrospective noninferiority study design.
- Involved a single pediatric inpatient rehabilitation unit.
- Compared functional outcomes (WeeFIM efficiency and DFQ change) between children under MCI and NCI.
Main Results:
- A total of 949 children were analyzed (899 NCI, 48 MCI).
- Modified contact isolation (MCI) showed noninferior functional outcomes compared to no contact isolation (NCI).
- WeeFIM efficiency and DFQ change were comparable between the MCI and NCI groups.
Conclusions:
- The modified contact isolation protocol is effective in achieving noninferior functional outcomes in pediatric inpatient rehabilitation.
- MCI offers a viable strategy for infection control without compromising patient functional progress.
- This protocol can guide practice amidst rising needs for contact isolation.
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